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Home My WebLink About0070 RIVER ROAD - Health j J 70 River Road LL�A arstons Mills 078 017001 /-7 d Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 70 River Road Property Address 1�+ Lawrence& Louise Corcoran Owner +— information is Owner's Name / required for every Marstons Mills t/ Ma 02648 7/2/2015 as page. Cityrrown State Zip Code Date of Inspection N Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms _ on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection Company Name 74 Beldan Ln. Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmail.com SI4522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 7/2/2015 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system ors" has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 0 geo1 Ys N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 70 River Road Property Address Lawrence& Louise Corcoran Owner Owner's Name information is Marstons Mills Ma 02648 7/2/2015 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The dwelling located at 70 River Rd Marstons Mills is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 2x27' leach trenches. The system was found to be in proper working condition at the time of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass'section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 70 River Road Property Address Lawrence& Louise Corcoran Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/2/2015 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 70 River Road Property Address Lawrence& Louise Corcoran Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/2/2015 page. City/Town state Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than Y2 day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 70 River Road Property Address Lawrence& Louise Corcoran Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/2%2015 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must,indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3M3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts -- Tide 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 70 River Road Property Address Lawrence& Louise Corcoran Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/2/2015 page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 331.52 gpd provided t5ins.3113 Title 5 Official Inspection Fenn:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts IN Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 70 River Road Property Address Lawrence& Louise Corcoran Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/2/2015 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 6/2015 Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 70 River Road Property Address Lawrence& Louise Corcoran Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/2/2015 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 70 River Road Property Address Lawrence& Louise Corcoran Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/2/2015 page. Cityfrown State Zip Code Date of Inspection D. System Information (coot.) Approximate age of all components, date installed (if known)and source of information: original system installed 10/31/2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.5 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joint were ok no leaks vented through the roof Septic Tank(locate on site plan): Depth below grade: feet Material of construction.- 0 concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons 6" Sludge depth: t5ins.3H 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 I`— Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 70 River Road Property Address Lawrence & Louise Corcoran Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/2/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top g of sludge to bottom of outlet tee or baffle 3.5 11 Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. Water.level was even with outlet, tank was not leaking and was structurally sound. Inlet and outlet covers on riser. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts - - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 70 River Road Property Address Lawrence& Louise Corcoran Owner owner's Name information is required for every Marstons Mills Ma 02648 7/2/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.3113 rifle 5 Official Inspection form:Subsurface sewage Disposal System•Page 11 of V Commonwealth of Massachusetts _ Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 70 River Road Property Address Lawrence& Louise Corcoran Owner Owner's Name information.is required for every Marstons Mills Ma 02648 7/2/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to.outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was in good condition, no rot,water level was even with outlet inverts. Cover is on a riser. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 't 70 River Road Property Address Lawrence& Louise Corcoran Owner Owner's Flame information is required for every Marstons Mills Ma 02648 7/2/2015 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2x27 ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): s.a.s. consists of 2 27' long x 4'wide leaching trenches with 2'stone under. Vegetation was normal, no sign of past hydraulic failure. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 70 River Road Property Address Lawrence& Louise Corcoran Owner Owner's Name information is Marstons Mills Ma 02648 7/2/2015 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 I Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 70 River Road Property Address Lawrence& Louise Corcoran Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/2/2015 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks- Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t Q I n") .3 33 z. G i -1 7' y 37 9,7 —a a. iy ' ` , 3s i t5ins•3113 Title 5 Official Inc_p8-'r n E.;m:S .su;the Seerece Disposat System-Page 15 of 17 Commonwealth of Massachusetts _ j Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 70 River Road Property Address Lawrence& Louise Corcoran Owner Owner's Name information is Marstons Mills Ma 02648 7/2/2015 required for every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5i--3$19 Title 6 Official tnspe�on Form Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 70 River Road Property Address Lawrence& Louise Corcoran Owner Owner's Name information is required for every Marstons Mills Ma 02648 7/2/2015 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABL�E LOCATION Lo+ 3 � i U2sr .n U SEWAGE # VILLAGE 08ES�NS � ASASrSES�SOR'S MAP & LOTO78.-0(7-QdI INSTALLER'S NAME&PHONE NO. .S • nevi Ia Cie a=� SEPTIC TANK CAPACITY / Sy 0 l/ I-S) (� LEACHING FACILITY: (type) L ` `C h (size) / x 5y ' NO. OF BEDROOMS 3 / BUILDER OR OWNER A M I `\ me—S PERMIT DATE: D .ZCOMPLIANCE_DATE: I D L3110 3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Weiland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by l��kc /� �� of �} �� . , 33 3-9 t 1 No. •Fee 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes r PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 3ppfication for r3i5pont *potem Construction Perron Application for a Permit to Construct(/)Repair( )Upgrade( )Abandon( ) Ili I Complete System ❑Individual Components Location ddress or Lot No. . 1 Ve o CCOTS, Owner's Name,Address and Tel.No. 'EOY 771 1 /STVV,� ^ijs. l ATE Nklocl Assessor's Ma cel '� °Z �;✓e r e JJ ® _` - mA In taller's ame,Address,and Tel.No. �pg—� �j® q 8i qCj D si ner' Name,Address and Tel.No. 5�(C� - '. t'✓s��G .� 6esi;,7/ jre.FF P C/n 13f� �� c�h�C S��t''�-- AAA 1 Type of Building: o Dwelling No.of Bedrooms Lot Size l �. � sq.ft. Garbage Grinder(v ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow j 3 1,0 '- gallons. Plan Date V aS a�� Number of shuts �- ((�� Revision Date Title l®T Flan —Frvprs.Sed ��c a5 Shc 'S�4✓ice .X 4Yi$`i�. PiSPOKC21 Size of Septic Tank Type of S.A.S. a' 10fcf Lz 0) T✓e,,%J7C Description of Soil �b ®" s. Lvr�w� ]Nature of Repairs or Alterations(Answer when applicable) �/�,✓ �9tw'9 5%��aC j ;� Date last inspected: Agreement: The undersigned agrees to eVbBoard nstruction and maintenance of the afore described on-site sewage disposal system in accordance with the provisionsf the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu of Health. Signed— _ Application Approved by Date Application Disapprove fort a following reas Permit No. Date Issued No. ' V° _ Fee0 { THE COMMONWEALTH;OF MASSACHUSETTS Entered in computer: �. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS . ZIpprication for Mizpaal *patent Contruction Permit Application for a Permit to Construct(I/)Repair( )Upgrade( )Abandon( ) 0/complete System O Individual Components,, Location ddress or Lot No.I 0 ;V e r oo. o7 Owner's Name,Address and Tel.No. D 7/ 3 �i�-- �y�trSTons W1I�I5. tMA Ed;T PA.'k, �o� ar,A Robs✓j Laic_ , N.,.Assessor's 1ppT cel ,0,17 06/ .'72 hi i✓e✓ � M p Installer's 1%ame,Address,and Tel.No. �pg—9 T3 y g�� D6?ir' Name,Addr ss and Tel.No. Sa3— S yo—9OD,- R.T. Be✓,)olcruv�. 13SS �e5i�n/F JcFF P7-rks.- P.O Bay, 628 ForC_5JC4/e M A o26�1 I �y tcr,,itiP.,�� Lee 8arss Rm.� a Type of Building: / no -- Dwelling -_ No.of Bedrooms (3 17,359 7 Lot Size 5 rj sq.ft. Garbage Grinder( ) Other Type of Building H No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow O gallons per day. C lculateddaily flow 3 3 �� gallons. Plan Date q 2S o2 Aumber of sheets ' {.- Revision'Date Title loT Plcfn "ProPo.Sed Hoc/Sa✓t 246S4r Fee-e ,—wage_ Di 5 FoSa S�STci Size of Septic Tank 1500 6ctl�or?� Type of S.A.S. 2' UcCP reach T✓Pd?c47r Description of Soil T,r�. .1 O`C1 S. Locia•� A j 1' y/�LG�:rv�,�� 2y—qq l M .Sa Grave/ C2j y —l� F;or San T � O-�' S. L d,., y-2 Cactw, c i., r-. SGv?J C'2 , __#_ 1 0Q:qS ;ature of Repairs or Alterations(Answer when'•applicable)f Date last inspected: F T l vi Agreement: The undersigned agrees to eVbBoard nstruction and maintenance of the afore described on-site sewage disposal system in,accordance with the provisionsf the Environmental Code and not-to place the system in operation until a Certifi- cate of Compliance has been issu of Health. Signe Date h. Application Approved by; Date Application Disapproved for the following yeas V Permit No. Date Issued„,(< ————————————— — THE C MMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO C RTIFY that the On-site Sewage Disposal System Constructed(X);Repaired ( )Upgraded( ) Abandoned )by v r/a L4 ! at t� I Vt'° o1 b n constructed in accordance ��. - with the pro sions o Title 5 and the for Disposal System Construction Permit No dated A. itj Installer �,3. I�Q✓/Iet cQ_l�fGl Designer QS p r if The issuance of this ge. �sha]Ldbt be construed as a guarantee that the system w' Date Inspector p --- --------.----'---------------- jpd ..- No. Fee C THE COMMONWEALTH OF MASSACHUSETTS �k r PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mif�pozar *pgtem Contruction Permit _ ? Permission is hereby granted to Construct(�)Repair( )Upgrade( )Abandon( ) System located at 7O I C I✓r✓ l�r�,.d/�? Mal✓sT0 h� PtA,jt S, MA and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constructio mus�be completed within three years of the date of this Date: U Approved by t� �k TOWN OF BARNSTABLE • e SEWAGE # LOCATION VII.LAGS Mrs�M5 M (-s ASSESSOR'S MAP &LOT617- 017-00 f INSTALLER'S NAME&PHONE NO. � �zy, ��CO SEPTIC TANK CAPACITY y�►rP�ie�t �{ x x 2 LEACHING FACILITY: (type) �� (size) 2 27 NO.OF BEDROOMS 3 p BUILDER OR OWNER PERMITDATE: 10 10 02 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted-.Groundwater Tableto the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by l � t� TOWN OF BAMS�TpABL1E LOCATION Lo+ 3 RAJ t7UI.�7L. 7U SEWAGE # ` • VILLAGE ��1`S','17nS /�� ASSESSOR'S MAP & LOTOW--0(7-001 nn_, - 11 Lr INSTALLER'S NAME&PHONE NO. �.�• l�/I IQ.CJ�c.tsi , SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Yp11C�n (size) �X5/ NO. OF BEDROOMS 43 BUILDER OR OWNER A M M5 Me--S PERMIT DATE: COMPLIANCE DATE: '1 D 31 ko 3 Separation Distance Between the: . Maximum Adjusted Groundwater Kahle to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i • 11 i '37` S 2. �s i • j I ` 1 - t FTI I i i - -�-��r !444 - j 2. p _. - _...._. .._. I' S p. 4 A .• _'.: I : .y 8 v. . < op -. QJQi1TiZy(-'-FZIZC�721.:. 5 9O \ " o I � xoot `T --� .4•.�0._ �i m ` ' _- ® i"au��" 1'\vYl � 5 8 428.6191 \._ ... --- u eAin UA p es'i ns ®1999 p •I .LK'F7St.:.TLZYi�j _. .i x-.zl'..: - Au s. io' ese e . I • a'. p 1p _... ♦ .. f T ){.• 2a�' 2.0 �' ,2�• 2.0' �a,•. .. SG : 1:p� 1.0` - � --��. _ p. � � `. i iX� .. AP 140, OL • - .y� 3 r f 1 Preliminary plans and layouts by DC.O.are for the tie of tne.r Customers only.Any other we is sn:Ctly Proni bite i ' 14ttTA I415UC_S4-/IrLLZ73�--_- :� � � . bp 00 I i I. µµ V TT V. 7. i. i i SGLE DATE y II 508.428.6191 u evl!i n - ! --- to ---_ e'signs All :. Rights ReserveG T i I� 71 �i E1:Rs7 F :FZOC�t .F1�Ln3tS•TS._--- — ---- --- 75 FT-1 I tI e� Prehm:na.y plans ano layouts by D.CD.are for the use or the-.r customer only.Any other use is tv.cuy Proh.orte i! i� �$„T'SHFJ1THrN -- -- — _ C 30 rNSUL. W . -_ PROP..V(3.rT . T I �I ,M Io a _ems �a - 1 U V s/4'TFaue-FcoO�S. r r I — " re r.:rsue - - I i _ sum€ — a . i rya--TaM suB r I r O _ r id I II S i r I 1 � �11 - -s I _. s l WiE_—__ • m.m ` 508 428.6191 o I D l�6evl i Ali o - - U34 m a esgns N Y I i copyright.®1999 All Rights O i dl !t I pese vl O ---- r . . -z'.to-x�� SSA _:_.--"i_. I I •'. b i i I lo•ma F-MMMM -- --— r ur rscxn_spuo s> s i (A) I F r '--`—'--7A - ' Pr ebmrnaiy plans and layouts by DC .are IOr the use of Ines customers only.Any or her use is strictly pro, brie ?• NOTES: AND UTILITY EASEMENT . � -ACCESS D E S I G N 1. LOT No 3 RIVER ROAD END OF EASEMENT LEGEND: 2. AS SESSORS No. ' PENDING � 3. • ZONING DISTRICT: VILLAGE BUSINESS A 55.80 X 56. _ 8 :: .PROPOSED SPOT GRADE 4: FLOOD ZONE. ZONE C 55.57 55.75 LAND SURVEYING' 55.70 PROPERTY LINECIVIL ENGINEERING 5. SPOT GRADE ELEVATIONS ARE BASED ON H GRADE AND ALIGNMENT . . MA TC GR CB■ CONCRETE BOUND TOWN TOPO MAPS BENCHMARK of EXrsnNG DRiVFwAr LAND PLANNING ' , ,, Cis Q I� .55.16 IP TOP OF CONC. BOUND ELEVATION 56.5 55: OD TEST PIT o. 6. ALL DISTURBED AR EAS `SHALL BE RESTORED 2 XI, OHW ' -' TO HSE 72 $SS Design, Incorporated EXISTING OVERHEAD WIRES WITH .6 OF'LOAM AND GRASS SEED. . . - 164 Katharine.Lee Bates Rd 'If � EXISTING RB. GAS 'SERVICE 7. RELOCATION 'OF GAS SERVICE TO EXISTING HOUSE Falmouth Massachusetts 02540 w EXISTING WATER MAIN TO BE 'DETERMINED BY GAS 'CO. & HAMILTON HOM � �� REPLACE EX/STING 2 WATER SERVICE N 48 01 58 E 30:76 ' 508.540.8805 FAX 508.548.8313 o EXISTING S. CONTRACTOR WITH NEW 2 SER NC� S NG` UTILITY POLE TR CTOR SHALL NOTIFY` DIG SAFE 72 HOURS N\F ED1TH IK1NA PRIOR TO ANY EXCAVATION. 0 1 Qs DEED: 3024/88 � � o 54.94 X 55.83 vi CONNECT NEW WIRE U77LI T7ES co Q W7H EXIS77NG WIRES AT POLE 0 N tWi1 rt 1CL -� h0 s 6- PINE N �16 E � -p ■56 x 55.13 .2 Sj ` 9. 6.50 UJ A tc`L' y ti O C/OLOT 2 S PI 0) t 2 PINE I--- tn X 55.87 56. z W 25 W LJJ d 1 I � UTILITY POLs� F- R POKE En 71/7 0 0 w s6.s6 >/1 D R OSED \ 14 CEDAR n 0 P >R� o 56.56 CONNECT NEW GAS LINE.:: Z W o WITV EVS77NG GAS SERVICE 0 -J U ,i / _ FF ELEV. 5�8 Q o v /� MA s O f44. 0 p Q �0 1..1.. 57.98 / y z I � Cn n +., 68 0- O (� 55. 12" CEDA ' � 1 a -� S 5�8 9 $ 16 K ^ LOT 3 55.09 •55,75 79 L.l.. W " r 56. Q wCD 56.45 - G 8 _ _ Q 17 358 SF r _ _ t ceor..e - ._ _ - n O o »,. J 57 - W r. O r; - ry I �. J T � '' .• N 56.0`Vic' - _L 'o 5 1 - / Z L/L'J :.:• v 18^ (� 8 P E 5 Q LL �O O X 52.48 i 1 Is n� r f r /' x 54.53 p 54 55 6L x,tom_ #3A PINE ABAN- QV10E 500-GAL _ r_ 56.20 to U_ 0 iv .� > PT X 54.27= _ X 52.52 8 --- nNc cAs S G AC'TJfNK �E - >� m o s PANE � ,�-�'f G 3,50 f--.� -� �_ �, _- a,. � � w ' (f} •53. 0 8" PINE __r - _ X1S�}� - sS 3 7t 56. 0 Qry �___ E G �� RCG / CL 55.81 20�MAPLES %= _--''- ..` / � UJ Q Q: 6.12 Z Q �` - - / 5.9� / _' 52.89 Sr ss64 G -- --- / TP __ I LOT 4 1 / 2 Sale \ ----------------'-G IST. G S SERVICE TO HOUSE IN REARS G �__---ar 9517 , 1 " 20' 55.39 G G 17,526 SF _ - 6 h� _ - -----�c-------- --- x 54.67 CJi Ov` date -------4---- 33rs1----------- ---- ----- -------- -- �n .53- 52.60 � � � .�6h SEP. 25, 2002 �� t 4'AP E� x 5.25 X 54.42 0' N UTILITY POLE ■ ti �` 5 drawn 71/6 OC S�Jr l / I'Y x 55.30 / � 4' x53.3o ,. � TJB/LMP/BRL � cv S48 09 08 W 22,60 / / checked N IJ�YILITY EASEMENT --- \ / FOR LOT 4 116 SF�S2 26- MAE -_3 MAPLE 5• X 52.29 • 3.95 ` 54.93 56,56.12 TWO 4X27x2' DEEP --__� / x 1 5 S48'09'0 'W _ 298.3 / CB FND job number LEACHING TRENCHES CB RE FND `� ( •55.79 TRENCH EXCA VA 77ON 1 / 24•• MARL DIMENSIONS. 4554' 2057.03 6°1 N\F EDWARD F & MARGARET BARRY revisions / & WILLIAM ASPDEN CB FND DEED: 4682/40to BM TOP CB _ ^�,�, ELEV - 56. 5 �Q N. terra � • GRAPHIC SCALE 20 0 10 20 40 80 )5348 ( Ixr r ) 1 inch 20 ft - drawing number - B11 -35D �� ¢ v w:-s � , :,. . ,� �� , .: „ _ ..<. ., X �- „ ,. , _ ... a _ , . r v . . r z ,, ,. . .,.�, _„ , ,, ..:..•, ; , , ,. , „ .. , ,;',. - „�, <., ,. ,, _ y ,,. ,,; „ «9 _ , >., - z ,,,�,. ,. y i _ , - ,, , D , ._ . ' . y - , ,, _ ,- ' Ft, : F EL• 58.8 , , _ , . „ , , „ _,. NG • _ YI �., �. ,. .:- k , , .. ;: , .. , , ., :.., , - :. .:. :.. ,. L" ENGINEERING �. ,, .. K s -: .. r „a r ,y)_ _ .,,. a ,. y .a. ::: �` .:.. 56.8 , - , . _... ., -. v :. a ." < .AN viQ C , N tN G . f m , . .,, 5 m _ __, u m py 4 - _ .. 5 5f , 2 s o e ,,, . 56.2 cox. , ,, ' . _ m _ 55.2 mi : ,. ., � .: z{ y., C ONCRETE , _ , A, N , ,_ FOUND TIO ; _ _ , ._. s C NCR 1 . 0 E RSRS iR , .. , ,. „ , TE E RE U ED Q I, .B Ss De s n Incor ., ate _ .._ _ - r d R COVERS & Y ::OTHE S , _ B , :.. TO RING RS > MTHf _ C VE N 6 ,_:_ 4 F 5 4 _. _ 25 0 P F P ... ,.. , ., _ . ER . 1PE P R °' 184 xat M E TRENCH berme Lee Ba ' , - ,- » > .:: „ _C A _ OF.F�INISH G A LE N _BACKFILL R DE Falmouth liassachnse ,. ,< ,, tts 0254. ,.... .. 4 r r m __ _P o , 5 08 540.8805 l'AX )p _ ,., _ 3 4 1 , _. . , <_ _ _„ _ 2 8 � 2 ea _, .. _. , _, _ _f stone _ 1 53.5 _ 4 . ` _ H > _. WAS ED STON E f __s 0 0.00 .5q , P o 5 _ `�-----_ ' o t e sl . . m, - P < _, P - L U D LEVEL _ Q „ _ „ ::. ., ,: 'S3.0 :._ _ 1b 0 m, CAP' PIP ,_. _ „ 53.27 ,• . E , 53.73 _: ♦ v I, •. ♦ N N 3 BA M T L 0 „ SE E . FOR , _ .. .; :, 2:77 >w • ♦. . 5 _. � 52.47 4 • • • 53:0 , .. 4., , - , sz , r ., > _ 4 <a ..+, . ,.. 52.60 , . . - ,. 50.47 , _ 4 F 2 0 STONE BE W P _.. _. LO IPE M, ^ W , , , . - I , 22 -�p T I.. I 1 8 ', 2 _ 7 2 l r < : , , ` .. .' , 2 _ DEEP LEACH TRENCHES 0 T SEPTIC ANK E _ DISTR _ IBUTION ....BOX , f, V) , _ , TWO TR N - _ . -3 H AA E CHES 4 DIA. :SCH D. 40 ': USE 1 500 GALLON AASHTO H10 is I- PERFOR _ _ ATED PVC PlP 4 E W1DE, - PRECAST SEPTIC 'TANK i w w .,,, , 7 _ . 2 LONG & .2 OF WASHE C� D....STONE BELOW, _. (n V T =. . BO TOM :AREA 108.0 `SF A H' TR (E C ENCHI) W >- D - S , H SU S R 1GH GN . B U FACE SEWAGE DISPOSAL SYSTEM D WATER ELEv. 0 , . Q , a ,. . NOT ENCOUNTERED Q NOT TO SCALE N, " o , to .. '. S - a. " `° n , . �- g 0 r cn r r _ , Q , ; (� , _ I , � W � _ w > c� D I R ; ES GN C I TERIA ,.TE S T H , �. Q . 0LE _DATA _ C O o W _J - .. //''��// U M ER OF N B BEDROOMS ` 3�:brm desr n _, DESIGN FLOW 110` d brm PERCOLATION RATE = <2 min inch * Z 9P r _O `, : _Q c� Z : . ,; T K N a w - TOTAL DAILY FLOW < 33 A E BY. : Lawrence M. Perr _ o d ,._. r 9 P Y - J w U) ; , _ . O \ ' Z G. IV RA nI ` WITN E E _ � 'I V 0 TE S ESSED BY. David Barnstable Health De Pt D o �•- :�: _ O 9 . m m. ._ n ' H CALCU LATI O V S DATE• , Jul 31 2002 Y o - r� ,. , , (/� i • _A s stem n corn o ents 'shall 'be installed -in accordance ` � r Y - P __ P 10295 O l . - CL' �.: .... _wi h h' t t e State Envrranmentol C ' e Tr I V od t e • Mrnrmum ,`J Q �. .., w : 24 allons C15 mins. TH 3a ® 44 62 m ..Sand .: SEPTIC TANK: � # c ) z o .: X . , -Q Re ulrements for the Subsurface Dis os` I of Sal a = J q p . a n tart' F �'. : : „ _ S Wa e n n a d a l ca e o l rules`: which ma be a licable DESIGN FOR USE WITHOUT AR 9 ,, Y Y PP G _ BALE GRINDER _ _ scale SOIL LOG SOIL LOG . : 7, , 2, The Barnstable Health fle t. must be notrfled 330 a da x 200% 660 al da . - P 9 r Y 9 r Y 1 20. TEST HOLE 1 . TE T w 1 'S00 al TANK MiN(MUM RE UIRE S HOLE 2 hen the s stem . rs installed and rior to backfrliin , 9 _ Q, D � # -: :: _ Y � P 9 t ' date - . L 5 � . ,, E 5, 0 EL 56.1 j for 'ins ection. 1 500 al H10 'SEPTIC TAN` PROVIDED 0 p 9 K , S P. 5 . . E 2 2002 A SANDY LOAM SANDY LOAM 3. The stone around the leachin i e shall consist of -washed A 9 PP „ „ • EL 55.0 9 EL 5. drawn stone ra r SO L ABSORPTION SYSTEM • 5 8 4 ng ng from, 3/4 to -1 - 1 2 inches in size and be free r B LOAM l3 LOAM BRL of. iron fines and dust in lace. The p stone shall be covered EL 53.7 24 EL 54.0 25 w TWO LEACHING TRENCHES, ,TWO PIPES, EACH checked ith at least a 2 in h c Ia er of washed stone ran rn from Y 9 9 25 LONG W SCHED. 40 PERFORAT D PV ., r E C• C1 MEDIUM '.SAND C1 MEDI>J�M SAND 1 /8 to 1 2 inch rn _ size, and be free of iron fines and dust. ' r , , AND GRAVEL AND GRAVEL 4 WIDE & 2 DEEP DOUBLE-WASHED STONE ob number rn place. - EL 52.0 44 EL 51.1 60 , 4. The rode above and ad 'ace t to the leachin _facilit shall `sio e 2057.03 9 J 9 Y P LEACHING AR A E PROVIDED. STATE TITLE V at least 2% ''to revent accumulation of surface water. revisions P • „ , , 5. Sewer i e shall p p be 4 diameter schedule 40 PVC or equal SIDEWALL `AREA• 2 ((4 + 54 )x 2 DP) 232.0 sf _ ,i at 1 /4 per_ foot (2%) slope to ank. 232.0 sf x 0.74 al sf da 171 .68 al da 9 r r Y 9 Y FINE SAND FINE SAND ,, 6. Con r C2 C2 t actor shall notify the Engineer if he/she 'encounters soil BOTTOM AREA: 2(4 x27 )x 0.74 gal/sf/day .. conditions other than those shown 'in the soil 'lo . -- . 9 = _159.84 gal/day TOTAL LEACHING CAPACITY = 331 .52 gpd DRY - DRY I EL 45.9 118 EL 46.4 117 I . : : _ -l.. .. 4 drawing number B11 -35D i ___ =��-. _ __ :